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Critical Care Medicine - MICU

            a) Rotation Description:  The Montefiore Medical Center MICU, on North 2 is a 14-bed ICU. It functions as a primary teaching unit admitting approximately 75 patients per month.

The unit is staffed with one attending, one to two fellows, four Medicine PGY-2s and four Medicine PGY-1s.  Approximately 6 months a year a fourth-year medical student is present as well. A critical Care attending and fellow is present in-house 24/7.  During their MICU rotation fellows will cover the unit M-F 6:30am-7pm.  Fellows and attendings take signout from 6:30-7am. From 7am-8am fellows attend morning report rounds.  MICU rounds with the attending, medical residents and interns, ICU nurses, respiratory therapists, dietician and pharmacist take place from approximately 8am-noon daily.  Fellows and attendings sign out to incoming night coverage from 6:30-7pm.   The Medical Director of the ICU is Lewis Eisen, MD.  The Medical Co-Director of the ICU is Adam Keene, MD.  The Nurse Manager of the ICU is Melba Garcia, RN.

Close relationships exist with the adjacent Echocardiography lab and Coronary Care Unit. The most frequent diagnoses at the time of admission to the Medical ICU are respiratory failure, septic shock, endocrine and metabolic emergencies, hemorrhagic shock, renal failure, hepatic failure, ischemic or hemorrhagic stroke, status epilepticus, oncologic emergencies, and neuromuscular crises. In addition, the unit functions as a primary site for emergency plasmapheresis for patients with TTP.

             b) Goals and Objectives:  The overarching goal of the Moses MICU rotation is to develop residents with full competence in caring for a variety of critically ill patients that are seen in the medical intensive care unit of a tertiary care teaching hospital.  The specific, competency-based goals and objectives are as follows:

 For Medical Interns (PGY-1)

 1.  Patient Care-

            Goal: Obtain competency in providing appropriate care to patients in a medical ICU.

            Objective:  Obtain competency in operation, interpretation, and troubleshooting mechanical ventilators and invasive monitoring devices.

            Objective:  Obtain knowledge of the advanced procedures required in the ICU including vascular access, airway management, thoracentesis, chest tube placement, and goal-directed ultrasound and echocardiography.

            Objective:   Obtain competency in appropriate ordering and interpretation of diagnostic laboratory and imaging tests for critically ill medical patients.

 2.  Medical Knowledge-        

            Goal:  Obtain and demonstrate knowledge of the diverse medical conditions encountered in the medical ICU.

            Objective:  Obtain and demonstrate knowledge of the pathophysiology and treatment of hypovolemic, distributive, obstructive, cardiogenic and neurogenic shock.

            Objective:  Obtain and demonstrate knowledge of the pathophysiology and treatment of respiratory, cardiac, renal, hepatic, neurologic and hematologic failure.

            Objective:  Obtain and demonstrate knowledge of salvage modalities for ARDS including recruitment maneuvers, airway pressure release ventilation, oscillatory ventilation, prone position ventilation, pulmonary vasodilators and the use of extracorporeal membrane oxygenation.

            Objective:  Obtain and demonstrate knowledge of diagnosis and management of infections in critically ill medical patients.

            Objective:  Obtain and demonstrate knowledge of diagnosis and management of ischemic and hemorrhagic stroke, status epilepticus, and neuromuscular diseases in critically ill medical patients.

            Objective:  Obtain and demonstrate knowledge of anaphylactic, toxic, metabolic, acid-base, and endocrinologic emergencies in critically ill medical patients.

 3.  Practice-Based Learning and Improvement-

            Goal: Obtain and demonstrate competency in appraisal and assimilation of scientific evidence in order to evaluate and improve their care of the medical ICU patient.

            Objective:  Demonstrate the ability to use information technology to locate, appraise, and assimilate the available evidence regarding appropriate care for patients in the medical ICU.

            Objective:  Demonstrate the ability to use information technology to access information and manage on-line medical information regarding patients in the medical ICU.

 4.  Professionalism-

            Goal:  To understand and demonstrate appropriate standards of professionalism for an intensivist in the medical ICU including adherence to ethical principles and sensitivity to diverse patient populations.

            Objective:  To demonstrate professional standards for an intensivist in the medical ICU by carrying out all responsibilities in a timely, appropriate, and reliable fashion.

            Objective:  To demonstrate professional standards for an intensivist in the medical ICU by interacting with patients, families, physicians, nurses, and other support staff in a respectful and appropriate manner.

            Objective:  To demonstrate professional standards for an intensivist in the medical ICU by showing respect for patient privacy and autonomy.

 5.  Interpersonal and Communication Skills-

            Goal:  To obtain and demonstrate interpersonal and communication skills that allow for the effective exchange of information and collaboration with patients, families, physicians, nurses, and other support staff in the medical ICU.

            Objective:  Obtain and demonstrate the ability to communicate effectively with a diverse group of critically ill patients and their families in the medical ICU.

            Objective:  Obtain and demonstrate the ability to effectively communicate and collaborate with physicians, nurses, and support staff under stressful conditions in the medical ICU.

 6.  Systems-Based Practice-

            Goal:  To obtain and demonstrate the ability to recognize and correct system errors while working effectively with a multidisciplinary team in the medical ICU.

            Objective:  To effectively work as part of a multidisciplinary team in addressing any unit-based quality deficiencies in the MICU.

            Objective:  To obtain and demonstrate the ability to promote best practices and enhance patient safety while working as part of a multidisciplinary team in the medical ICU.

  

For Medical Residents (PGY-2)

 1.  Patient Care-

            Goal: Obtain competency in providing appropriate care to patients in a medical ICU.

            Objective:  Obtain competency in operation, interepretation, and troubleshooting mechanical ventilators and invasive monitoring devices.

            Objective:  Obtain knowledge of the advanced procedures required in the ICU including vascular access, airway management, thoracentesis, chest tube placement, and goal-directed echocardiography.

            Objective:   Obtain competency in appropriate ordering and interpretation of diagnostic laboratory and imaging tests for critically ill medical patients.

            Objective: Obtain competency in guiding PGY-1s and medical students in the admission and subsequent management of critically ill patients.

 2.  Medical Knowledge-        

            Goal:  Obtain and demonstrate knowledge of the diverse medical conditions encountered in the the medical ICU.

            Objective:  Obtain and demonstrate knowledge of the pathophysiology and treatment of hypovolemic, distributive, obstructive, cardiogenic and neurogenic shock.

            Objective:  Obtain and demonstrate knowledge of the pathophysiology and treatment of respiratory, cardiac, renal, hepatic, neurologic and hematologic failure.

            Objective:  Obtain and demonstrate knowledge of salvage modalities for ARDS including recruitment, airway pressure release ventilation, oscillatory ventilation, prone position ventilation, pulmonary vasodilators and the use of extracorporeal membrane oxygenation.

            Objective:  Obtain and demonstrate knowledge of diagnosis and management of infections in critically ill medical patients.

            Objective:  Obtain and demonstrate knowledge of diagnosis and management of ischemic and hemorrhagic stroke, status epilepticus, and neuromuscular diseases in critically ill medical patients.

            Objective:  Obtain and demonstrate knowledge of anaphylactic, toxic, metabolic, acid-base, and endocrinologic emergencies in critically ill medical patients.

            Objective:  Obtain and demonstrate knowledge of ventilator management for common conditions such as ARDS, status asthmaticus and pneumonia.

            Objective:  Obtain and demonstrate knowledge of common vasopressors and inotropes used in the ICU.

 3.  Practice-Based Learning and Improvement-

            Goal: Obtain and demonstrate competency in appraisal and assimilation of scientific evidence in order to evaluate and improve their practices in the care of the medical ICU patient.

            Objective:  Demonstrate the ability to use information technology to locate, appraise, and assimilate the available evidence regarding appropriate care for patients in the medical ICU.

            Objective:  Demonstrate the ability to use information technology to access information and manage on-line medical information regarding patients in the medical ICU.

            Objective:  Demonstrate the ability to facilitate the learning of students, residents, and other healthcare professionals in the medical ICU.

 4.  Professionalism-

            Goal:  To understand and demonstrate appropriate standards of professionalism for an intensivist in the medical ICU including adherence to ethical principles and sensitivity to diverse patient populations.

            Objective:  To demonstrate professional standards for an intensivist in the medical ICU by carrying out all responsibilities in a timely, appropriate, and reliable fashion.

            Objective:  To demonstrate professional standards for an intensivist in the medical ICU by interacting with patients, families, physicians, nurses, and other support staff in a respectful and appropriate manner.

            Objective:  To demonstrate professional standards for an intensivist in the medical ICU by showing respect for patient privacy and autonomy.

            Objective:  To demonstrate team leadership skills commensurate with training level and the knowledge to ask for help when indicated.

 5.  Interpersonal and Communication Skills-

            Goal:  To obtain and demonstrate interpersonal and communication skills that allow for the effective exchange of information and collaboration with patients, families, physicians, nurses, and other support staff in the medical ICU.

            Objective:  Obtain and demonstrate the ability to communicate effectively with a diverse group of critically ill patients and their families in the medical ICU.

            Objective:  Obtain and demonstrate the ability to effectively discuss treatment options at the end of life with critically ill patients and their families in the medical ICU.

            Objective:  Obtain and demonstrate the ability to effectively communicate and collaborate with physicians, nurses, and support staff under stressful conditions in the medical ICU.

            Objective:  To take a progressive leadership role in discussions with patients and family members.

 6.  Systems-Based Practice-

            Goal:  To obtain and demonstrate the ability to recognize and correct system errors while working effectively with a multidisciplinary team in the medical ICU.

            Objective:  To effectively contribute to unit-based QI projects in the MICU.

            Objective:  To effectively work as part of a multidisciplinary team in addressing any unit-based quality deficiencies in the MICU.

            Objective:  To obtain and demonstrate the ability to promote best practices and enhance patient safety while working as part of a multidisciplinary team in the medical ICU.

            Objective:  To intercept or mitigate errors of team members. 




2012
Written by: Lewis Eisen, M.D.

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